Journal of urban health : bulletin of the New York Academy of Medicine
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The purpose of this study is to explore how marginalization, substance abuse, and service utilization influence the transitions between streets, shelters, and housed states over the course of 2 years in a population of urban homeless adults. Survey responses from three yearly interviews of 400 homeless adults were matched with administrative services data collected from regional health, mental health, and housing service providers. To estimate the rates of transition between housed, street, and shelter status, a multi-state Markov model was developed within a Bayesian framework. ⋯ Remaining on the streets was uniquely associated with engagement in "shadow work" and, surprisingly, a high use of routine services. These findings paint a picture of unique and separate processes for different types of housing transitions. These results reinforce the importance of focusing interventions on the needs of these unique housing transitions, paying particular attention to prior housing patterns, substance abuse, and the different ways that homeless adults are marginalized in our society.
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Mobility is a key aspect of active ageing enabling participation and autonomy into later life. Remaining active brings multiple physical but also social benefits leading to higher levels of well-being. With globally increasing levels of urbanisation alongside demographic shifts meaning in many parts of the world this urban population will be older people, the challenge is how cities should evolve to enable so-called active ageing. ⋯ Our analysis identified three critical intersecting and interacting thematic problems for urban mobility amongst older people: The quality of physical infrastructure; issues around the delivery, governance and quality of urban systems and services; and the attitudes and behaviors of individuals that older people encounter. This identified complexity reinforces the need for policy responses that may not necessarily involve design or retrofit measures, but instead might challenge perceptions and behaviors of use and access to urban space. Our co-design results further highlight that solutions need to move beyond the generic and placeless, instead embedding specific locally relevant solutions in inherently geographical spaces, populations and processes to ensure they relate to the intricacies of place.
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Obesity and frequent mental and physical distress are often associated with major health problems. The characteristics of the urban environment, such as homicide rates and public goods provision, play an important role in influencing participation in physical activity and in overall mental health. This study aimed to determine whether there was a relationship between homicide rates and public goods provision on the health outcomes of the citizens of Cali, Colombia, a city known for its high urban violence rate and low municipal investment in public goods. ⋯ On average, the presence of one additional bus station increased the probability of being obese or overweight by 1.1%, the probability of frequent mental distress by 0.3% (95% CI = 0.001-0.004), and the probability of frequent physical distress by 0.02% (95% CI = 0.000-0.003). Living in districts with adequate public space and lighted parks lowers the probability of being obese and high homicide rates, which are correlated with poor health outcomes in Cali, Colombia. Investments in public goods provision and urban safety to reduce obesity rates may contribute to a better quality of life for the population.